|
CTA CHEST
|
Facility
|
IP
|
$4,422.40
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
2351014
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$317.10 |
| Max. Negotiated Rate |
$4,201.28 |
| Rate for Payer: Cash Price |
$2,653.44
|
| Rate for Payer: Cash Price |
$2,653.44
|
| Rate for Payer: Cigna Commercial |
$3,759.04
|
| Rate for Payer: First Health Commercial |
$3,980.16
|
| Rate for Payer: First Health Workers Compensation |
$448.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,980.16
|
| Rate for Payer: GEHA Commercial |
$3,095.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,980.16
|
| Rate for Payer: Multiplan All |
$4,024.38
|
| Rate for Payer: OMNI Networks Commercial |
$3,095.68
|
| Rate for Payer: One Health Plan PPO/POS |
$3,980.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,201.28
|
| Rate for Payer: Three Rivers Provider Network All |
$3,316.80
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,112.83
|
| Rate for Payer: Zelis Auto |
$1,768.96
|
| Rate for Payer: Zelis Worker's Compensation |
$317.10
|
|
|
CTA CHEST
|
Facility
|
OP
|
$4,422.40
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
2351014
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$143.68 |
| Max. Negotiated Rate |
$4,201.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$510.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,653.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$510.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$404.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$169.04
|
| Rate for Payer: Cash Price |
$2,653.44
|
| Rate for Payer: Cash Price |
$2,653.44
|
| Rate for Payer: Cigna Commercial |
$3,759.04
|
| Rate for Payer: First Health Commercial |
$3,980.16
|
| Rate for Payer: First Health Workers Compensation |
$448.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,980.16
|
| Rate for Payer: GEHA Commercial |
$3,537.92
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,980.16
|
| Rate for Payer: Humana ChoiceCare |
$185.94
|
| Rate for Payer: Humana Medicare Advantage |
$169.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$283.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$412.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$169.04
|
| Rate for Payer: Multiplan All |
$4,024.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$3,095.68
|
| Rate for Payer: One Health Plan PPO/POS |
$3,980.16
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$476.66
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$412.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$169.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,201.28
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$3,316.80
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$3,759.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$412.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,112.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$1,768.96
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$317.10
|
|
|
CTA CHEST PE
|
Facility
|
IP
|
$4,422.40
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
2300156
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$317.10 |
| Max. Negotiated Rate |
$4,201.28 |
| Rate for Payer: Cash Price |
$2,653.44
|
| Rate for Payer: Cash Price |
$2,653.44
|
| Rate for Payer: Cigna Commercial |
$3,759.04
|
| Rate for Payer: First Health Commercial |
$3,980.16
|
| Rate for Payer: First Health Workers Compensation |
$448.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,980.16
|
| Rate for Payer: GEHA Commercial |
$3,095.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,980.16
|
| Rate for Payer: Multiplan All |
$4,024.38
|
| Rate for Payer: OMNI Networks Commercial |
$3,095.68
|
| Rate for Payer: One Health Plan PPO/POS |
$3,980.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,201.28
|
| Rate for Payer: Three Rivers Provider Network All |
$3,316.80
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,112.83
|
| Rate for Payer: Zelis Auto |
$1,768.96
|
| Rate for Payer: Zelis Worker's Compensation |
$317.10
|
|
|
CTA CHEST PE
|
Facility
|
OP
|
$4,422.40
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
2300156
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$143.68 |
| Max. Negotiated Rate |
$4,201.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$510.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,653.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$510.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$404.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$169.04
|
| Rate for Payer: Cash Price |
$2,653.44
|
| Rate for Payer: Cash Price |
$2,653.44
|
| Rate for Payer: Cigna Commercial |
$3,759.04
|
| Rate for Payer: First Health Commercial |
$3,980.16
|
| Rate for Payer: First Health Workers Compensation |
$448.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,980.16
|
| Rate for Payer: GEHA Commercial |
$3,537.92
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,980.16
|
| Rate for Payer: Humana ChoiceCare |
$185.94
|
| Rate for Payer: Humana Medicare Advantage |
$169.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$283.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$412.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$169.04
|
| Rate for Payer: Multiplan All |
$4,024.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$3,095.68
|
| Rate for Payer: One Health Plan PPO/POS |
$3,980.16
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$476.66
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$412.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$169.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,201.28
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$3,316.80
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$3,759.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$412.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,112.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$1,768.96
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$317.10
|
|
|
CTA GI BLEED PROTOCOL
|
Facility
|
OP
|
$6,549.00
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
2374174
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$6,221.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$838.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,929.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$838.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$664.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$3,929.40
|
| Rate for Payer: Cash Price |
$3,929.40
|
| Rate for Payer: Cigna Commercial |
$5,566.65
|
| Rate for Payer: First Health Commercial |
$5,894.10
|
| Rate for Payer: First Health Workers Compensation |
$606.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,894.10
|
| Rate for Payer: GEHA Commercial |
$5,239.20
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,894.10
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$677.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$5,959.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$4,584.30
|
| Rate for Payer: One Health Plan PPO/POS |
$5,894.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$782.46
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$677.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,221.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$4,911.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$5,566.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$677.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,090.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$2,619.60
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$428.94
|
|
|
CTA GI BLEED PROTOCOL
|
Facility
|
IP
|
$6,549.00
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
2374174
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$428.94 |
| Max. Negotiated Rate |
$6,221.55 |
| Rate for Payer: Cash Price |
$3,929.40
|
| Rate for Payer: Cash Price |
$3,929.40
|
| Rate for Payer: Cigna Commercial |
$5,566.65
|
| Rate for Payer: First Health Commercial |
$5,894.10
|
| Rate for Payer: First Health Workers Compensation |
$606.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,894.10
|
| Rate for Payer: GEHA Commercial |
$4,584.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,894.10
|
| Rate for Payer: Multiplan All |
$5,959.59
|
| Rate for Payer: OMNI Networks Commercial |
$4,584.30
|
| Rate for Payer: One Health Plan PPO/POS |
$5,894.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,221.55
|
| Rate for Payer: Three Rivers Provider Network All |
$4,911.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,090.57
|
| Rate for Payer: Zelis Auto |
$2,619.60
|
| Rate for Payer: Zelis Worker's Compensation |
$428.94
|
|
|
CTA HEAD
|
Facility
|
IP
|
$4,087.00
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
2351439
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$352.45 |
| Max. Negotiated Rate |
$3,882.65 |
| Rate for Payer: Cash Price |
$2,452.20
|
| Rate for Payer: Cash Price |
$2,452.20
|
| Rate for Payer: Cigna Commercial |
$3,473.95
|
| Rate for Payer: First Health Commercial |
$3,678.30
|
| Rate for Payer: First Health Workers Compensation |
$498.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,678.30
|
| Rate for Payer: GEHA Commercial |
$2,860.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,678.30
|
| Rate for Payer: Multiplan All |
$3,719.17
|
| Rate for Payer: OMNI Networks Commercial |
$2,860.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,678.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,882.65
|
| Rate for Payer: Three Rivers Provider Network All |
$3,065.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,800.91
|
| Rate for Payer: Zelis Auto |
$1,634.80
|
| Rate for Payer: Zelis Worker's Compensation |
$352.45
|
|
|
CTA HEAD
|
Facility
|
OP
|
$4,087.00
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
2351439
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$143.68 |
| Max. Negotiated Rate |
$3,882.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$510.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,452.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$510.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$404.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$169.04
|
| Rate for Payer: Cash Price |
$2,452.20
|
| Rate for Payer: Cash Price |
$2,452.20
|
| Rate for Payer: Cigna Commercial |
$3,473.95
|
| Rate for Payer: First Health Commercial |
$3,678.30
|
| Rate for Payer: First Health Workers Compensation |
$498.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,678.30
|
| Rate for Payer: GEHA Commercial |
$3,269.60
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,678.30
|
| Rate for Payer: Humana ChoiceCare |
$185.94
|
| Rate for Payer: Humana Medicare Advantage |
$169.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$283.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$412.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$169.04
|
| Rate for Payer: Multiplan All |
$3,719.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$2,860.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,678.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$476.66
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$412.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$169.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,882.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$3,065.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$3,473.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$412.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,800.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$1,634.80
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$352.45
|
|
|
CTA LE
|
Facility
|
IP
|
$3,979.00
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
2410104
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$358.48 |
| Max. Negotiated Rate |
$3,780.05 |
| Rate for Payer: Cash Price |
$2,387.40
|
| Rate for Payer: Cash Price |
$2,387.40
|
| Rate for Payer: Cigna Commercial |
$3,382.15
|
| Rate for Payer: First Health Commercial |
$3,581.10
|
| Rate for Payer: First Health Workers Compensation |
$506.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,581.10
|
| Rate for Payer: GEHA Commercial |
$2,785.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,581.10
|
| Rate for Payer: Multiplan All |
$3,620.89
|
| Rate for Payer: OMNI Networks Commercial |
$2,785.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,581.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,780.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,984.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,700.47
|
| Rate for Payer: Zelis Auto |
$1,591.60
|
| Rate for Payer: Zelis Worker's Compensation |
$358.48
|
|
|
CTA LE
|
Facility
|
OP
|
$3,979.00
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
2410104
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$143.68 |
| Max. Negotiated Rate |
$3,780.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$510.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,387.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$510.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$404.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$169.04
|
| Rate for Payer: Cash Price |
$2,387.40
|
| Rate for Payer: Cash Price |
$2,387.40
|
| Rate for Payer: Cigna Commercial |
$3,382.15
|
| Rate for Payer: First Health Commercial |
$3,581.10
|
| Rate for Payer: First Health Workers Compensation |
$506.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,581.10
|
| Rate for Payer: GEHA Commercial |
$3,183.20
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,581.10
|
| Rate for Payer: Humana ChoiceCare |
$185.94
|
| Rate for Payer: Humana Medicare Advantage |
$169.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$283.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$412.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$169.04
|
| Rate for Payer: Multiplan All |
$3,620.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$2,785.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,581.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$476.66
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$412.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$169.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,780.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$2,984.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$3,382.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$412.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,700.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$1,591.60
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$358.48
|
|
|
CTA LE RIGHT
|
Facility
|
OP
|
$3,979.00
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
2351438
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$143.68 |
| Max. Negotiated Rate |
$3,780.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$510.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,387.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$510.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$404.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$169.04
|
| Rate for Payer: Cash Price |
$2,387.40
|
| Rate for Payer: Cash Price |
$2,387.40
|
| Rate for Payer: Cigna Commercial |
$3,382.15
|
| Rate for Payer: First Health Commercial |
$3,581.10
|
| Rate for Payer: First Health Workers Compensation |
$506.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,581.10
|
| Rate for Payer: GEHA Commercial |
$3,183.20
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,581.10
|
| Rate for Payer: Humana ChoiceCare |
$185.94
|
| Rate for Payer: Humana Medicare Advantage |
$169.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$283.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$412.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$169.04
|
| Rate for Payer: Multiplan All |
$3,620.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$2,785.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,581.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$476.66
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$412.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$169.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,780.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$2,984.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$3,382.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$412.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,700.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$1,591.60
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$358.48
|
|
|
CTA LE RIGHT
|
Facility
|
IP
|
$3,979.00
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
2351438
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$358.48 |
| Max. Negotiated Rate |
$3,780.05 |
| Rate for Payer: Cash Price |
$2,387.40
|
| Rate for Payer: Cash Price |
$2,387.40
|
| Rate for Payer: Cigna Commercial |
$3,382.15
|
| Rate for Payer: First Health Commercial |
$3,581.10
|
| Rate for Payer: First Health Workers Compensation |
$506.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,581.10
|
| Rate for Payer: GEHA Commercial |
$2,785.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,581.10
|
| Rate for Payer: Multiplan All |
$3,620.89
|
| Rate for Payer: OMNI Networks Commercial |
$2,785.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,581.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,780.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,984.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,700.47
|
| Rate for Payer: Zelis Auto |
$1,591.60
|
| Rate for Payer: Zelis Worker's Compensation |
$358.48
|
|
|
CTA NECK
|
Facility
|
IP
|
$4,147.60
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
2351440
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$359.61 |
| Max. Negotiated Rate |
$3,940.22 |
| Rate for Payer: Cash Price |
$2,488.56
|
| Rate for Payer: Cash Price |
$2,488.56
|
| Rate for Payer: Cigna Commercial |
$3,525.46
|
| Rate for Payer: First Health Commercial |
$3,732.84
|
| Rate for Payer: First Health Workers Compensation |
$508.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,732.84
|
| Rate for Payer: GEHA Commercial |
$2,903.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,732.84
|
| Rate for Payer: Multiplan All |
$3,774.32
|
| Rate for Payer: OMNI Networks Commercial |
$2,903.32
|
| Rate for Payer: One Health Plan PPO/POS |
$3,732.84
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,940.22
|
| Rate for Payer: Three Rivers Provider Network All |
$3,110.70
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,857.27
|
| Rate for Payer: Zelis Auto |
$1,659.04
|
| Rate for Payer: Zelis Worker's Compensation |
$359.61
|
|
|
CTA NECK
|
Facility
|
OP
|
$4,147.60
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
2351440
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$143.68 |
| Max. Negotiated Rate |
$3,940.22 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$510.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,488.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$510.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$404.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$169.04
|
| Rate for Payer: Cash Price |
$2,488.56
|
| Rate for Payer: Cash Price |
$2,488.56
|
| Rate for Payer: Cigna Commercial |
$3,525.46
|
| Rate for Payer: First Health Commercial |
$3,732.84
|
| Rate for Payer: First Health Workers Compensation |
$508.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,732.84
|
| Rate for Payer: GEHA Commercial |
$3,318.08
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,732.84
|
| Rate for Payer: Humana ChoiceCare |
$185.94
|
| Rate for Payer: Humana Medicare Advantage |
$169.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$283.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$412.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$169.04
|
| Rate for Payer: Multiplan All |
$3,774.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$2,903.32
|
| Rate for Payer: One Health Plan PPO/POS |
$3,732.84
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$476.66
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$412.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$169.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,940.22
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$3,110.70
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$3,525.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$412.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,857.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$1,659.04
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$359.61
|
|
|
CTA PELVIS
|
Facility
|
OP
|
$3,618.00
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
2351015
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$143.68 |
| Max. Negotiated Rate |
$3,437.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$510.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,170.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$510.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$404.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$169.04
|
| Rate for Payer: Cash Price |
$2,170.80
|
| Rate for Payer: Cash Price |
$2,170.80
|
| Rate for Payer: Cigna Commercial |
$3,075.30
|
| Rate for Payer: First Health Commercial |
$3,256.20
|
| Rate for Payer: First Health Workers Compensation |
$452.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,256.20
|
| Rate for Payer: GEHA Commercial |
$2,894.40
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,256.20
|
| Rate for Payer: Humana ChoiceCare |
$185.94
|
| Rate for Payer: Humana Medicare Advantage |
$169.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$283.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$412.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$169.04
|
| Rate for Payer: Multiplan All |
$3,292.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$2,532.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,256.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$476.66
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$412.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$169.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,437.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$2,713.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$3,075.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$412.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,364.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$1,447.20
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$320.26
|
|
|
CTA PELVIS
|
Facility
|
IP
|
$3,618.00
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
2351015
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$320.26 |
| Max. Negotiated Rate |
$3,437.10 |
| Rate for Payer: Cash Price |
$2,170.80
|
| Rate for Payer: Cash Price |
$2,170.80
|
| Rate for Payer: Cigna Commercial |
$3,075.30
|
| Rate for Payer: First Health Commercial |
$3,256.20
|
| Rate for Payer: First Health Workers Compensation |
$452.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,256.20
|
| Rate for Payer: GEHA Commercial |
$2,532.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,256.20
|
| Rate for Payer: Multiplan All |
$3,292.38
|
| Rate for Payer: OMNI Networks Commercial |
$2,532.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,256.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,437.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,713.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,364.74
|
| Rate for Payer: Zelis Auto |
$1,447.20
|
| Rate for Payer: Zelis Worker's Compensation |
$320.26
|
|
|
CTA UE
|
Facility
|
OP
|
$3,651.00
|
|
|
Service Code
|
CPT 73206
|
| Hospital Charge Code |
2410091
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$143.68 |
| Max. Negotiated Rate |
$3,468.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$510.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,190.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$510.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$404.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$169.04
|
| Rate for Payer: Cash Price |
$2,190.60
|
| Rate for Payer: Cash Price |
$2,190.60
|
| Rate for Payer: Cigna Commercial |
$3,103.35
|
| Rate for Payer: First Health Commercial |
$3,285.90
|
| Rate for Payer: First Health Workers Compensation |
$475.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,285.90
|
| Rate for Payer: GEHA Commercial |
$2,920.80
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,285.90
|
| Rate for Payer: Humana ChoiceCare |
$185.94
|
| Rate for Payer: Humana Medicare Advantage |
$169.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$283.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$412.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$169.04
|
| Rate for Payer: Multiplan All |
$3,322.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$2,555.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,285.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$476.66
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$412.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$169.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,468.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$2,738.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$3,103.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$412.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,395.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$1,460.40
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$336.21
|
|
|
CTA UE
|
Facility
|
IP
|
$3,651.00
|
|
|
Service Code
|
CPT 73206
|
| Hospital Charge Code |
2410091
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$336.21 |
| Max. Negotiated Rate |
$3,468.45 |
| Rate for Payer: Cash Price |
$2,190.60
|
| Rate for Payer: Cash Price |
$2,190.60
|
| Rate for Payer: Cigna Commercial |
$3,103.35
|
| Rate for Payer: First Health Commercial |
$3,285.90
|
| Rate for Payer: First Health Workers Compensation |
$475.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,285.90
|
| Rate for Payer: GEHA Commercial |
$2,555.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,285.90
|
| Rate for Payer: Multiplan All |
$3,322.41
|
| Rate for Payer: OMNI Networks Commercial |
$2,555.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,285.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,468.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,738.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,395.43
|
| Rate for Payer: Zelis Auto |
$1,460.40
|
| Rate for Payer: Zelis Worker's Compensation |
$336.21
|
|
|
CTA UE RIGHT
|
Facility
|
IP
|
$3,651.00
|
|
|
Service Code
|
CPT 73206
|
| Hospital Charge Code |
2351017
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$336.21 |
| Max. Negotiated Rate |
$3,468.45 |
| Rate for Payer: Cash Price |
$2,190.60
|
| Rate for Payer: Cash Price |
$2,190.60
|
| Rate for Payer: Cigna Commercial |
$3,103.35
|
| Rate for Payer: First Health Commercial |
$3,285.90
|
| Rate for Payer: First Health Workers Compensation |
$475.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,285.90
|
| Rate for Payer: GEHA Commercial |
$2,555.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,285.90
|
| Rate for Payer: Multiplan All |
$3,322.41
|
| Rate for Payer: OMNI Networks Commercial |
$2,555.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,285.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,468.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,738.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,395.43
|
| Rate for Payer: Zelis Auto |
$1,460.40
|
| Rate for Payer: Zelis Worker's Compensation |
$336.21
|
|
|
CTA UE RIGHT
|
Facility
|
OP
|
$3,651.00
|
|
|
Service Code
|
CPT 73206
|
| Hospital Charge Code |
2351017
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$143.68 |
| Max. Negotiated Rate |
$3,468.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$510.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,190.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$510.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$404.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$169.04
|
| Rate for Payer: Cash Price |
$2,190.60
|
| Rate for Payer: Cash Price |
$2,190.60
|
| Rate for Payer: Cigna Commercial |
$3,103.35
|
| Rate for Payer: First Health Commercial |
$3,285.90
|
| Rate for Payer: First Health Workers Compensation |
$475.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,285.90
|
| Rate for Payer: GEHA Commercial |
$2,920.80
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,285.90
|
| Rate for Payer: Humana ChoiceCare |
$185.94
|
| Rate for Payer: Humana Medicare Advantage |
$169.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$283.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$412.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$169.04
|
| Rate for Payer: Multiplan All |
$3,322.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$2,555.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,285.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$476.66
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$412.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$169.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,468.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$2,738.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$3,103.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$412.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,395.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$1,460.40
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$336.21
|
|
|
CT BONE LGTH STUDY (SCANO)
|
Facility
|
OP
|
$687.00
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
2477073
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$38.16 |
| Max. Negotiated Rate |
$652.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$412.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna Commercial |
$583.95
|
| Rate for Payer: First Health Commercial |
$618.30
|
| Rate for Payer: First Health Workers Compensation |
$53.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$618.30
|
| Rate for Payer: GEHA Commercial |
$549.60
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$618.30
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$625.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$480.90
|
| Rate for Payer: One Health Plan PPO/POS |
$618.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$652.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$515.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$583.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$638.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$274.80
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$38.16
|
|
|
CT BONE LGTH STUDY (SCANO)
|
Facility
|
IP
|
$687.00
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
2477073
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$38.16 |
| Max. Negotiated Rate |
$652.65 |
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna Commercial |
$583.95
|
| Rate for Payer: First Health Commercial |
$618.30
|
| Rate for Payer: First Health Workers Compensation |
$53.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$618.30
|
| Rate for Payer: GEHA Commercial |
$480.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$618.30
|
| Rate for Payer: Multiplan All |
$625.17
|
| Rate for Payer: OMNI Networks Commercial |
$480.90
|
| Rate for Payer: One Health Plan PPO/POS |
$618.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$652.65
|
| Rate for Payer: Three Rivers Provider Network All |
$515.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$638.91
|
| Rate for Payer: Zelis Auto |
$274.80
|
| Rate for Payer: Zelis Worker's Compensation |
$38.16
|
|
|
CT CALCIUM SCORE
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
2380023
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$34.85 |
| Max. Negotiated Rate |
$238.53 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$43.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$120.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$43.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$34.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$170.00
|
| Rate for Payer: First Health Commercial |
$180.00
|
| Rate for Payer: First Health Workers Compensation |
$238.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$180.00
|
| Rate for Payer: GEHA Commercial |
$160.00
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$180.00
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$35.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$182.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$140.00
|
| Rate for Payer: One Health Plan PPO/POS |
$180.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$41.06
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$35.56
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$190.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$150.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$170.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$35.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$186.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$80.00
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$168.66
|
|
|
CT CALCIUM SCORE
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
2380023
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$238.53 |
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$170.00
|
| Rate for Payer: First Health Commercial |
$180.00
|
| Rate for Payer: First Health Workers Compensation |
$238.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$180.00
|
| Rate for Payer: GEHA Commercial |
$140.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$180.00
|
| Rate for Payer: Multiplan All |
$182.00
|
| Rate for Payer: OMNI Networks Commercial |
$140.00
|
| Rate for Payer: One Health Plan PPO/POS |
$180.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$190.00
|
| Rate for Payer: Three Rivers Provider Network All |
$150.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$186.00
|
| Rate for Payer: Zelis Auto |
$80.00
|
| Rate for Payer: Zelis Worker's Compensation |
$168.66
|
|
|
CT CHEST LOW DOSE
|
Facility
|
IP
|
$1,192.00
|
|
|
Service Code
|
CPT 71271
|
| Hospital Charge Code |
2300297
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$127.18 |
| Max. Negotiated Rate |
$1,132.40 |
| Rate for Payer: Cash Price |
$715.20
|
| Rate for Payer: Cash Price |
$715.20
|
| Rate for Payer: Cigna Commercial |
$1,013.20
|
| Rate for Payer: First Health Commercial |
$1,072.80
|
| Rate for Payer: First Health Workers Compensation |
$179.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,072.80
|
| Rate for Payer: GEHA Commercial |
$834.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,072.80
|
| Rate for Payer: Multiplan All |
$1,084.72
|
| Rate for Payer: OMNI Networks Commercial |
$834.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,072.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,132.40
|
| Rate for Payer: Three Rivers Provider Network All |
$894.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,108.56
|
| Rate for Payer: Zelis Auto |
$476.80
|
| Rate for Payer: Zelis Worker's Compensation |
$127.18
|
|
